Abstract
There is increasing evidence to support the safety and reliability of ultrasound-guided regional anaesthesia (regional nerve ‘blocks’ using local anaesthetic drugs) in the setting of elective orthopaedic surgery. In response to a patient safety incident that occurred while under general anaesthesia (GA), we set out to offer awake regional nerve blocks to high-risk patients as a safe alternative to GA. Between September 2010 and July 2011, 43 patients scheduled for elective upper limb surgery on ‘high-risk lists’ were given a regional anaesthetic for their operation. Patients were followed up by telephone interview 24 hours post-surgery to monitor complications and to gain patient feedback. We also assessed regional anaesthesia in terms of efficiency and patient satisfaction. Overall 42/43 patients were successfully blocked (1/43 converted to GA). ‘Blocked’ patients were able to bypass the ‘post anaesthesia care unit’, and could proceed straight to the ward after their operation in the majority of cases. Nobody was dissatisfied with their anaesthetic, and 40/41 would chose regional anaesthesia again over GA. Ultrasound-guided regional anaesthesia is a reliable alternative to GA and is associated with high patient acceptability. In the setting of a UK NHS district general hospital, availability of ultrasound-guided regional anaesthesia may help to improve patient safety, patient choice and postoperative efficiency. The findings of the service evaluation support our ongoing use of this technique.
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